Bronchial Asthma: Stepwise Management in Children Less than 5 Years

Management of bronchial asthma in children is provided as a stepwise treatment. Health-care professionals recommend children with asthma to start medication at the step most suitable to the initial severity of the disease. They may recommend moving up stepwise to achieve asthma control as required or moving down stepwise to seek and keep up lowest controlling step. If the response to treatment is not adequate, health-care professional should check compliance to treatment and reconsider the diagnosis.

Step 1

Step 1 is ideal to manage mild intermittent bronchial asthma in children less than five years. An inhaled short-acting β2 agonist (SABA) such as Salbutamol is offered at step 1 as required.

If asthma control is inadequate with step 1,

Check inhaler technique and correct it.
Check compliance to the medication.
Move up to step 2, if inhaler technique and compliance are satisfactory.

Step 2

Step 2 is suitable to children, who cannot manage bronchial asthma with step 1, as a regular preventer therapy. Health-care professionals will recommend adding an inhaled steroid such as Beclometasone dipropionate, Budesonide, Mometasone furoate, or Fluticasone propionate 200-400 µg/day. If drug delivery is difficult, higher doses of inhaled steroid may be needed. Otherwise, it is recommended adding a leukotriene receptor antagonist such as Montelukast or Zafirlukast, if inhaled steroid cannot be taken. The dose of inhaled steroid depends on the severity of bronchial asthma.

If asthma control is inadequate with step 2,

Check inhaler technique and correct it.
Check compliance to the medication.
Move up to step 3, if inhaler technique and compliance are satisfactory.

Consider moving down to step 1, if asthma control is adequate with step 2.

Step 3

Step 3 is appropriate to children, who cannot control asthma with step 2, as an initial add-on therapy. In children less than two years, health-care professionals will consider to proceed directly to step 4. They will recommend taking an inhaled steroid such as Beclometasone dipropionate or equivalent 200-400 µg/day with a leukotriene receptor antagonist in children between two to five years.

If asthma control is inadequate with step 3,